The situation of dental health service management regarding the universal health insurance policy

Abstract:

The situation of dental health service management regarding the universal health insurance policyThis study aimed at exploring the situation of dental health service management since the first launch of universal health insurance policy, and to determine the impact of the policy on utilization and provision of the treatment service including the dental benefit package of the hospitals as well as health promotion and prevention program. The result is used partly for further implementation and for policy recommendation on dental health service.Three provinces : Payao, Pathumthani, and Yala were selected as target areas of which universal health insurance policy was implemented since 1 April 2001. This study includes 1 regional/general hospital and 1 community hospital in each of the 3 province, making totally 6 health facilities in this study. The data on treatment service was secondary data collected, by statistical package program, from the daily client’s record attending the dental clinic at the hospitals in the workdays of odd numbers in April - December 2001 and 2002. The data on health promotion derived from interviewing dental health personnel in each province. The data was then processed, analyzed, concluded and reported.The result on treatment service revealed that the number of hospital visits at the 6 health facilities has increased by 26.6 %, and the number of clients has risen by 20.2 %. In overall, the service coverage was 6.36 %, the regional/general hospitals coverage was 5.44 % and the community hospital coverage was 9.06 %. In regional/general hospitals, the population group with highest increasing rate of hospital visits at 30.2 % was those over 60 years of age who received basic health care service not the dental care. The proportion of those aged over 60 years having hospital visits was about 6 – 7 % of the total population, while the visits was declined to 6.0 % among those aged 0 – 4 years and 5 – 9 years.The percentage of those shifting from buying health insurance card to the gold health insurance cards in this project and receiving hospital service has somewhat increased from 9.1 % to 10.2 %, while the percentage has risen from 1.5 % to 22.2 % for community hospitals. Those shifted from the low income card to the gold cards have increased hospital visits from 15.4 % to 18.5 %, of which have increased among the low income group and the elderly. However the percentage of visiting community hospitals has reduced from 46.0 % to 35.2 % among the disable, the elderly, and those aged 0 – 12 years. Regarding repeated dental health service, it was found that the average visit of one client is 1.29 and 1.35 times in 2001 and 2002. The proportion of those having only one visit somewhat reduced from 81.2 % in 2001 and 78.0 % in 2002. The increasing rate was higher among the old patients than the new ones.With respect to the service types provided, the first 3 types of dental service provided were the basic service, i.e. tooth extraction, tooth filling, scaling, and the proportion of each type has not changed during 2001 and 2002.Considering the service types received at each visit, the percentage of those receiving only dental check up has increased about 41.1 %. If the dental check up is not regarded as a type of service, then almost 80 % had attended only one service type at each visit which was 31.8 % higher than the last year rate.The type of services under the health insurance benefit package was classified by population groups : pre-school age (0 – 5 years), school age (6 – 12 years), youth and working age (13 – 59 years), and the old age (over 60 years). The result suggested that there has been an increase of all types of basic service, i.e. tooth extraction, tooth filling, scaling, (including periodontitis treatment in the clients aged over 13 years), accounting for more than 90 % of the services under the benefit package. Whereas other services such as wearing acrylic base denture, root canal treatment presented less proportion.For dental health promotion and prevention service, the dental section of each hospital provides oral check up for pregnant women at ante-natal clinic and well-baby clinic, included in the dental health program for the target groups continuously implemented since before 2001. Each hospital does not change this activity but differs in implementing methods and duration.Regarding pre-school age service in Amphur Mueng, all hospitals have not yet implemented dental health promotion in the child development center and in kindergarten classes of primary schools.For school age children service, prior to 2001, primary schools were included in responsible area of various health service facilities. After the launch of universal health insurance policy, regional/general hospitals remain their responsibility to those schools under the catchment area of the hospital but cover more numbers of schools. These hospitals accept and commit health promotion and prevention as hospital functions. However, regional/general hospital personnel thought that school health promotion and prevention should be implemented by dental workers.In the areas outside Amphur Mueng, the dental health section of some community hospitals did not implement dental health promotion and prevention program in child development center, however, all of them have carried out dental health surveillance and prevention program in primary schools covering the same numbers of schools and activities during 2001 and 2002.Regarding home service and visit, the dentists working in the dentistry group and dental health section did not involve in preparing family files. These health facilities did not arrange certain service activities that support self reliance of the people.According to the findings, the treatment service is 6.36 % coverage of the total population. The analysis suggested that since the first implementation of dental health project in the 4th National Economic and Social Development Plan, it would yield 10 % coverage. Considering the service access classified by age, it was found that the proportion of children and the elderly receiving dental care, comparing to the total population, is less than those of other groups. Thus, it should be taken into consideration on the issue of service management that identifies specific targets with suitable proportion.Taking into account the needs and desire for treatment service in comparison with the service result, and the data on human resources, budget and time, the guidelines for identifying direction of dental health service system at provincial level could be developed particularly on the output standard of dental health service benefit package. It is noted that regional and community hospital have different patterns of providing service types in the benefit package. It is thus recommended that dental health service system assessment at national level is to be undertaken to monitor and reflect the actual picture of the service to the province and the administrators.An outreach preventive implementation at community level is a crucial answer to effectively solve the dental problem of the people. Hence, service system management without focussing on the community and prevention cannot stop the rapid increase of the problems.